{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:50:03Z","timestamp":1786978203287,"version":"build-2736575974"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Vaginal candidiasis is the second most common cause of vaginal infection worldwide, affecting nearly 70\u201375% of women at least once during their lifetime, with recurrence in approximately 45%. In Ayurveda, its clinical presentation resembles\n                      <jats:italic>\u015alai\u1e63mik\u012b Yonivy\u0101pad<\/jats:italic>\n                      . Preliminary clinical evidence suggests\n                      <jats:italic>Yoni Prak\u1e63\u0101lana<\/jats:italic>\n                      (vaginal douche) with\n                      <jats:italic>Triphal\u0101 Ka\u1e63\u0101ya<\/jats:italic>\n                      improves the clinical symptoms within the first 7 days of therapy. Classical Ayurvedic texts recommended combining\n                      <jats:italic>Triphal\u0101 Ka\u1e63\u0101ya<\/jats:italic>\n                      and\n                      <jats:italic>Gom\u016btra<\/jats:italic>\n                      for\n                      <jats:italic>srava-pradh\u0101na \u015alai\u1e63mik\u012b Yonivy\u0101pat<\/jats:italic>\n                      , but, to date, no randomized controlled studies have explored the potential additive effect of\n                      <jats:italic>Gom\u016btra Arka<\/jats:italic>\n                      with\n                      <jats:italic>Triphal\u0101 Ka\u1e63\u0101ya<\/jats:italic>\n                      using microbiological outcome assessment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To generate preliminary clinical and microbiological outcome estimates and evaluate the safety of adding\n                      <jats:italic>Gom\u016btra Arka<\/jats:italic>\n                      to\n                      <jats:italic>Triphal\u0101 Ka\u1e63\u0101ya Yoni Prak\u1e63\u0101lana<\/jats:italic>\n                      in women with vaginal candidiasis, thereby informing the design of future confirmatory randomized controlled trials.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A single-center, open-label, randomized exploratory clinical trial (CTRI\/2024\/08\/072177) enrolled 36 of 42 screened participants and randomized (1:1 allocation) into two groups (18 per group). 32 participants (16 per group) completed study and were analyzed. Group A received\n                      <jats:italic>Triphal\u0101 Ka\u1e63\u0101ya Yoni Prak\u1e63\u0101lana<\/jats:italic>\n                      alone, and Group B received\n                      <jats:italic>Triphal\u0101 Ka\u1e63\u0101ya<\/jats:italic>\n                      combined with\n                      <jats:italic>Gom\u016btra Arka<\/jats:italic>\n                      for 7 consecutive days. Outcomes were assessed on Day 0, 3, 5, and 8. The exploratory primary outcome was change in candida spore count quantified using ImageJ software. Exploratory secondary outcome was changes in vaginal discharge and pruritus, assessed using discharge grading scale and the 5-D Pruritus Scale. Safety was prospectively monitored throughout the intervention by adverse event surveillance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both groups showed improvement in clinical symptoms and microbiological parameters. Exploratory analyses suggested earlier improvements in vaginal discharge, pruritus and Candida spore count in the combination group. Exploratory analyses suggested between-group differences from Day 5 onwards; however, these observations should be interpreted as hypothesis-generating rather than confirmatory evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The addition of\n                      <jats:italic>Gom\u016btra Arka<\/jats:italic>\n                      to\n                      <jats:italic>Triphal\u0101 Ka\u1e63\u0101ya Yoni Prak\u1e63\u0101lana<\/jats:italic>\n                      was feasible and associated with favorable exploratory clinical and microbiological outcomes. These preliminary findings support adequately powered multicentre randomized controlled trials to confirm therapeutic effectiveness and further evaluate safety and mechanisms of action.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/ctri.nic.in\/Clinicaltrials\/pmaindet2.php?EncHid=MTEwODU2&amp;amp;Enc=&amp;amp;userName=<\/jats:ext-link>\n                      , identifier: CTRI\/2024\/08\/072177.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1910053","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:33:12Z","timestamp":1786599192000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploratory randomized open-label clinical trial of Triphal\u0101 Ka\u1e63\u0101ya vaginal douche (Yoni prak\u1e63\u0101lana) with and without Gom\u016btra Arka in vaginal candidiasis"],"prefix":"10.3389","volume":"13","author":[{"given":"Roshini","family":"Chandrashekar","sequence":"first","affiliation":[{"name":"Department of Stri Roga and Prasuti Tantra (Gynecology and Obstetrics), Amrita School of Ayurveda, Amrita Vishwa Vidyapeetham","place":["Amritapuri, Kollam, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjaly","family":"Muraleedharan","sequence":"additional","affiliation":[{"name":"Department of Stri Roga and Prasuti Tantra (Gynecology and Obstetrics), Amrita School of Ayurveda, Amrita Vishwa Vidyapeetham","place":["Amritapuri, Kollam, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemavathi","family":"Shivapura Krishnarajabhatt","sequence":"additional","affiliation":[{"name":"Department of Stri Roga and Prasuti Tantra (Gynecology and Obstetrics), Amrita School of Ayurveda, Amrita Vishwa Vidyapeetham","place":["Amritapuri, Kollam, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinu Mithra Nisa","family":"Sushilal","sequence":"additional","affiliation":[{"name":"Department of Stri Roga and Prasuti Tantra (Gynecology and Obstetrics), Amrita School of Ayurveda, Amrita Vishwa Vidyapeetham","place":["Amritapuri, Kollam, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvathy","family":"Unnikrishnan","sequence":"additional","affiliation":[{"name":"Department of Stri Roga and Prasuti Tantra (Gynecology and Obstetrics), Amrita School of Ayurveda, Amrita Vishwa Vidyapeetham","place":["Amritapuri, Kollam, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"4778","DOI":"10.4103\/jfmpc.jfmpc_489_20","article-title":"Health care seeking behaviour among rural women in Telangana: a cross-sectional study","volume":"9","author":"Reddy","year":"2020","journal-title":"J Family Med Prim Care."},{"key":"B2","doi-asserted-by":"publisher","first-page":"18358","DOI":"10.1038\/s41598-020-74655-z","article-title":"Vaginal microbiota evaluation and prevalence of key pathogens in Ecuadorian women: an epidemiologic analysis","volume":"10","author":"Salinas","year":"2020","journal-title":"Sci Rep."},{"key":"B3","first-page":"0815","article-title":"Candidiasis (vulvovaginal)","volume":"2015","author":"Martin Lopez","year":"2015","journal-title":"BMJ Clin Evid."},{"key":"B4","doi-asserted-by":"publisher","first-page":"119","DOI":"10.4161\/viru.22913","article-title":"Candida albicans pathogenicity mechanisms","volume":"4","author":"Mayer","year":"2013","journal-title":"Virulence."},{"key":"B5","doi-asserted-by":"publisher","first-page":"139","DOI":"10.4103\/0253-7184.192121","article-title":"Prevalence of asymptomatic infections in sexually transmitted diseases attendees diagnosed with bacterial vaginosis, vaginal candidiasis, and trichomoniasis","volume":"37","author":"Rajalakshmi","year":"2016","journal-title":"Indian J Sex Transm Dis AIDS."},{"key":"B6","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s12905-019-0748-8","article-title":"Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes","volume":"19","author":"Yano","year":"2019","journal-title":"BMC Womens Health."},{"key":"B7","volume-title":"D.C. 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